A total of 262 subjects will be enrolled in about 400 patient interventions and about 200 outpatient interventions over 5 years. Subjects will be randomized to treatment w various glucocorticoids/placebo alone or along w metabolic manipulations (caloric restriction/loading, lipolysis stimulation/ inhibition, etc.). The primary end points are leptin levels in plasma and gene expression in subcutaneous abdominal fat cells.